Diabetic Macular Edema: What to Know

Diabetic macular edema (DME) is a complication of diabetic retinopathy, which is when fluid builds up in the macula or the center portion of the retina. It’s the most common cause of vision loss in people with diabetes, which is the leading cause of new blindness in the United States.

Thankfully, there are several steps you can take to help prevent diabetic macular edema. If you’re already experiencing diabetic macular edema, there are several treatment options to help alleviate symptoms of the condition. 

This article will discuss the symptoms, causes, treatments, and risk factors of diabetic macular edema.

Potential Risk Factors Associated With Diabetic Macular Edema - Illustration by Daniel Fishel

Verywell / Daniel Fishel

Types of Diabetic Macular Edema

There are two key types of diabetic macular edema: non-central-involved diabetic macular edema (mild) and central-involved diabetic macular edema (severe).

Mild vs. Severe Diabetic Macular Edema

With non-central-involved diabetic macular edema, you have retinal thickening in the macula that is one millimeter or greater in diameter around the fovea, but it doesn’t involve the central subfield zone of the macula. In central-involved diabetic macular edema, the retinal thickening, which is one millimeter or larger in diameter, does involve the central subfield of the macula—often causing progressive vision loss.

Tests for Diabetic Macular Edema

To determine if you have diabetic macular edema, your healthcare provider may use one or more of the following tests:

  • Visual acuity test: This is the standard test you typically take at your yearly eye exam. It consists of a chart with letters and numbers that decrease in size as you read from the top down. Your healthcare professional usually asks you to cover one eye and read from the lowest line you can see clearly, and then you’ll switch eyes. 
  • The Amsler Grid: With this test, you can wear reading glasses if you typically use them. The grid is placed at the same distance you’d normally place a newspaper or a book when reading them. You’ll cover one eye and mark any parts of the grid that aren’t clear. You’ll switch eyes and again mark the chart. 
  • Dilated eye exam: Your healthcare provider will administer eye drops that will cause your pupils to widen. Once they’re dilated, your healthcare provider will examine the retina to see if there’s fluid buildup around the macula. 
  • Optical coherence tomography: Using a special light and camera, your healthcare professional will look to see if the retina is thick, how thick, and if the macula is swollen. 
  • Fluorescein angiography: To see if there’s any damage (or how much) to the macula, your healthcare professional will inject dye into your arm, which travels through the blood vessels. A camera photographs your retina during this process to see if there’s damage or disease related to diabetic macular edema.

Symptoms of Diabetic Macular Edema

Vision changes are the primary symptoms of diabetic macular edema. These include blurred or distorted vision near or in the center of your field of vision. Colors may also appear dull or washed out.

Causes of Diabetic Macular Edema

Diabetic macular edema is a complication of diabetes that evolves over time due to poor blood sugar control. It doesn’t occur on its own. Consistently high blood sugar can damage the small blood vessels in your eye.

Initially, this damage starts as diabetic retinopathy, which can impair your vision. If left untreated, fluid from these damaged blood vessels can leak into the macula, which results in diabetic macular edema.

Who Gets Diabetic Macular Edema 

Anyone with type 1 or type 2 diabetes can get diabetic macular edema.

Prevalence of Diabetic Macular Edema

According to the National Eye Institute, approximately 7.7 million Americans have diabetic retinopathy. Of those, approximately 10% have diabetic macular edema. Non-Hispanic African Americans are three times more likely to have diabetic macular edema than non-Hispanic Whites.

Risk Factors for Diabetic Macular Edema

Several risk factors could lead to diabetic macular edema. These include: 

Treating Diabetic Macular Edema

Treatments for diabetic macular edema start with treating diabetes itself. However, depending on the type or severity of your diabetic macular edema, you may need additional treatments. These include injectable anti-vascular endothelial growth factor (anti-VEGF) medications, laser therapy, and anti-inflammatory treatments. 

Injectable Anti-VEGF Medications

Anti-VEGF medications work to block new blood vessels from developing while also stopping leakage from abnormal blood vessels that could flood the macula.

These drugs are injected directly into the eye, so you may experience some mild pressure. Your healthcare provider will determine how many injections you’ll need to see results. 

The American Diabetes Association recommends anti–VEGF injections as a first-line treatment for most people with central-involved diabetic macular edema that impairs vision.

Laser Therapy

Using laser light, your healthcare provider will try to close and destroy any blood vessels that are leaking into the macula. Typically pain-free, this procedure can help slow or stop the growth of new blood vessels that may further damage your vision.

While laser therapy can help protect your vision and possibly even improve it some, there’s also the possibility you could have permanent blind spots.

Anti-Inflammatory Medications

Corticosteroids can be used to reduce swelling of the blood vessels that leads to increased fluid in the macula. They’re administered by using pills, eye drops, or injections in the eye.

To reduce the number of injections, there’s an option to put an implant in the eye that contains a sustained-release corticosteroid. If your eye doesn’t respond to steroids or you experience side effects due to steroids, your healthcare provider may try nonsteroidal anti-inflammatory drugs (NSAIDs). 

According to the American Diabetes Association, persons who have persistent diabetic macular edema despite receiving anti–VEGF therapy (or those who are not candidates for this treatment) may benefit from laser therapy or corticosteroid injections into the eye.

Preventing Diabetic Macular Edema

The best prevention for diabetic macular edema is managing your diabetes and following a healthy lifestyle. Maintaining proper blood sugar levels, coupled with keeping your cholesterol and blood pressure in check, is important in preventing diabetic macular edema.

It’s also imperative to get regular eye exams, including the dilated eye exam, so your healthcare provider can monitor any changes to your vision and check for possible eye damage.

How Often Should I Get an Eye Exam?

The American Diabetes Association recommends:

  • Adults with type 1 diabetes receive an initial dilated and comprehensive eye examination within five years of diagnosis.
  • Persons newly diagnosed with type 2 diabetes undergo an eye exam shortly after diagnosis.

Those with normal exams and well-controlled blood sugar levels may be screened every one to two years. If diabetic retinopathy is present, dilated retinal examinations should be performed at least annually—and possibly more often.

If you’re pregnant, particularly if you have diabetes, it’s crucial to have an eye exam with dilation during your pregnancy and undergo close monitoring if needed.


Summary 

Regardless of type, people with diabetes are at higher risk of developing diabetic macular edema, particularly if they already have diabetic retinopathy. Monitoring your eye health by receiving annual eye exams with dilation is crucial to detecting vision changes or damage to blood vessels that could lead to diabetic macular edema.

If you’re diagnosed with diabetic macular edema, there are treatments to effectively treat the condition and preserve your vision.

A Word From Verywell

The onset of diabetic macular edema doesn’t mean you’ll lose your vision. There are effective therapies to treat and repair damage to the macula and blood vessels in your eye to prevent diabetic macular edema from becoming severe. 

The key to preventing diabetic macular edema is to properly manage your diabetes to avoid consistently high blood sugar levels. Keeping your blood pressure and cholesterol levels in check will also aid in preventing diabetic macular edema.

If you’ve noticed changes in your vision or have concerns regarding diabetic macular edema, speak to your primary healthcare provider. They can assess your condition and determine next steps to prevent or alleviate diabetic macular edema.

Frequently Asked Questions

  • Does diabetic macular edema go away?

    While diabetic macular edema can’t be cured, the damage to the macula can be treated and reduced to preserve your vision. It’s important to maintain good blood sugar levels and follow a healthy lifestyle to keep diabetic macular edema from becoming more severe.

  • Is macular edema always caused by diabetes?

    While macular edema is often caused by diabetes, there are other possible causes. For instance, if you have eye surgery for conditions such as cataracts, glaucoma, or retinal disease, you could develop macular disease following the surgery. Age-related macular degeneration and inflammatory diseases also could lead to macular edema.

  • Are bananas good for macular degeneration?

    Yes, bananas deliver nutrients that could boost eye health and help prevent macular degeneration. These include folic acid and vitamin B6, as well as carotenoids, which are antioxidants that protect your eyes. A healthy diet of fruits and vegetables will continue to boost eye health and ward off macular degeneration.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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